MEDICARE: MARCIA MICHAELS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	00219	IA
2	106H00000X	Marriage & Family Therapist	T1017	OR
3	106H00000X	Marriage & Family Therapist	50275	CA

General Provider Information

NPI Number	:	1225129950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA MICHAELS

Provider Business Mailing Address
First Line	:	PO BOX 82819
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97282-0819
Country	:	US
Telephone Number	:	503-233-5405
Fax Number	:	503-233-2692

Provider Business Practice Location Address
First Line	:	7455 SW BEVELAND RD
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-8610
Country	:	US
Telephone Number	:	503-624-2600
Fax Number	:	503-624-7752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/24/2015

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Directions to “ MARCIA MICHAELS ” Practice Location

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